Avaliação da anamastose espleno-renal distal, com e sem ligadura da artéria esplênica, para tratamento a hipertensão portal esquistossomática

OBJETIVO: Avaliar os resultados da derivação espleno-renal distal (DERD) com ligadura da artéria esplênica (LAE) em pacientes com hipertensão portal esquistossomótica e história de sangramento por varizes esôfago-gástricas. MÉTODO: Estudo prospectivo de trinta pacientes que foram divididos em dois grupos: 15 foram submetidos à DERD (Grupo I) e 15 foram submetidos à DERD associada à LAE (Grupo II). Os pacientes foram acompanhados por 24 meses, e estudados quanto à recorrência de hemorragia digestiva por ruptura de varizes, controle endoscópico das varizes e permeabilidade da anastomose através de ultra-sonografia e angiografia. RESULTADOS: Um paciente do Grupo I (6,67%) apresentou trombose da anastomose e recidiva hemorrágica em decorrência de varizes. No Grupo II, nenhum paciente, em dois anos de observação, desenvolveu trombose da anastomose e hemorragia digestiva. Não houve diferença estatisticamente significativa entre os grupos. Quanto à análise endoscópica após seis meses, houve redução do tamanho ou desaparecimento das varizes em 80% dos pacientes do Grupo I e em 93% daqueles do Grupo II. CONCLUSÕES: A derivação espleno-renal distal com ligadura da artéria esplênica não está associada a uma maior incidência de trombose da anastomose, de recidiva hemorrágica e nem modificou o tamanho das varizes esôfago-gástricas em comparação com a derivação espleno-renal distal isolada.

Retalho sural estendido de pedículo distal

OBJETIVO: Mostrar a possibilidade da utilização do 1/3 proximal da perna como região doadora para o retalho fasciocutâneo sural de pedículo distal. MÉTODO: Estudo prospectivo de cinco casos operados para o tratamento de feridas de diversas etiologias na região distal da perna e pé, com utilização de retalho sural de pedículo distal abrangendo tecido da região superior da perna. Os tamanhos dos retalhos, e dos pedículos, e a incidência de perda parcial e total dos retalhos foram avaliados. RESULTADOS: Todos os casos tiveram uma evolução final satisfatória, com cicatrização da ferida e preservação anatômica e funcional do membro. Houve necrose parcial da área cutânea em dois retalhos. Não houve perda total de nenhum dos retalhos. Em dois casos necessitamos de mais de um tempo cirúrgico. CONCLUSÕES: A utilização de tecido fasciocutâneo da região superior da perna, correspondente ao trajeto subfascial do nervo, é possível e confere ao cirurgião a possibilidade de confeccionar retalhos mais amplos para tratar lesões mais extensas do tornozelo ou com pedículos mais longos para tratar as regiões do retropé e mediopé.

Método trigonométrico para o acesso à veia basílica no terço distal do braço

OBJETIVO: Determinar parâmetros anátomo-cirúrgicos para o acesso rápido, seguro e preciso da veia basílica no terço distal do braço e avaliar os aspectos anatômicos relacionados à presença, número e sintopia neural na região. MÉTODO: Foram utilizados 30 membros superiores de cadáveres adultos, brasileiros, do sexo masculino (27 a 58 anos), fixados em solução de formalina a 10%. Foi criado um método trigonométrico utilizando-se parâmetros anatômicos, determinando-se um triângulo cujo ápice foi o ponto de referência para a localização da veia basílica no terço distal do braço. A região foi dissecada e a veia exposta. O método foi também utilizado na dissecação venosa de 15 pacientes. RESULTADOS: A veia basílica foi encontrada na face medial do terço distal do braço de todos os cadáveres, localizando-se no ápice do trígono em 70% dos casos e em situação medial em relação ao mesmo em 30%. Em 83,33% havia ramos dos nervos cutâneos mediais do braço e antebraço junto à adventícia da veia basílica. Foram encontrados dois ramos dos nervos cutâneos mediais do braço e antebraço relacionados a cada veia basílica em 90% dos membros superiores e apenas um ramo no restante. Em 30% dos casos existiam ramos posteriores à veia basílica, o que deve ser considerado ao se realizar a dissecação da mesma. CONCLUSÕES: O método proposto para a localização da veia basílica mostrou-se eficaz, rápido, seguro e preciso, indicando ser uma boa opção de acesso venoso no paciente em estado crítico que necessite de tal procedimento.

Influence of distal ileum exclusion on hepatic and renal functions in presence of extrahepatic cholestasis

OBJECTIVE: To verify whether the ileal exclusion interferes with liver and kidney functional changes secondary to extrahepatic cholestasis.METHODS: We studied 24 rats, divided into three groups with eight individuals each: Group 1 (control), Group 2 (ligation of the hepatic duct combined with internal biliary drainage), and Group 3 (bile duct ligation combined with internal biliary drainage and exclusion of the terminal ileum). Animals in Group 1 (control) underwent sham laparotomy. The animals of groups 2 and 3 underwent ligation and section of the hepatic duct and were kept in cholestasis for four weeks. Next, they underwent an internal biliary bypass. In Group 3, besides the biliary-enteric bypass, we associated the exclusion of the last ten centimeters of the terminal ileum and carried out an ileocolic anastomosis. After four weeks of monitoring, blood was collected from all animals of the three groups for liver and kidney biochemical evaluation (albumin, ALT, AST, direct and indirect bilirubin, alkaline phosphatase, cGT, creatinine and urea).RESULTS: there were increased values of ALT, AST, direct bilirubin, cGT, creatinine and urea in rats from Group 3 (p < 0.05).CONCLUSION: ileal exclusion worsened liver and kidney functions in the murine model of extrahepatic cholestasis, being disadvantageous as therapeutic procedure for cholestatic disorders.

Vascular trauma in the Amazon - the challenge of great distances

ABSTRACTObjective:to evaluate the incidence of unfavorable outcomes in vascular trauma patients and their possible correlation to the distance between the city where the injury was sustained and the hospital where the patient received definitive treatment.Methods:descriptive and retrospective study. Data were collected from medical records of patients submitted to surgical procedures for arterial or venous injuries from February 2011 to February 2013 at the only trauma center providing vascular surgery in a vast area of the Amazon region. Trauma date, patient gender and age, mechanism and anatomic topography of injury, surgical management, need for surgical re-intervention, hospitalization period, postoperative complications, mortality and limb amputation rates were analyzed. The incidence of unfavorable outcomes was assessed according to the distance between the city where the vascular injury was sustained and the trauma center.Results: One hundred seventy-three patients with 255 vascular injuries were analyzed; 95.95% were male (p<0.05), mean age of 28.92 years; 47.4% were caused by firearm projectiles (p<0.05); topographic distribution: 45.66% lower limbs (p<0.05), 37.57% upper limbs, 6.94% abdominal, 5.2% thoracic and 4.62% were cervical vascular injuries; 51.42% of patients required hospitalization for seven days or less (p<0.05); limb amputation was necessary in 15.6% and the overall mortality was 6.36%.Conclusion:distances greater than 200Km were associated to longer hospitalization period; distances greater than 300Km were associated to increased limb amputation probability; severe vascular trauma have an increased death probability when patients need to travel more than 200Km for surgical treatment.

The Sedimentology, Ichnology and Hydrogeochemistry of the Late Miocene, Marginal Marine, Upper Pebas and Nauta Formations, Amazonian Foreland Basin, Peru

This thesis includes detailed sedimentological and ichnological studies on two geological units: the Pebas Formation, with a special focus in its informal upper member, and the Nauta Formation. Both formations were deposited during the Miocene in Northeastern Peruvian Amazonia, in the Amazon retroarc foreland basin. The Pebas and Nauta successions mainly consist of non-consolidated, clastic sedimentary deposits arranged into sand- to mud-dominated heterolithic successions, which can be upward-coarsening to upward-fining. Sediments in both the Pebas and Nauta successions range from mud to fine- to medium-grained sand. The main facies observed were 1) mud-dominated horizontal heterolithic couplets; 2) rooted brownish mud; 3) lenticular, mud-draped, cross-stratified sand; 4) mud- to sand-dominated, inclined heterolithic stratification; 5) sand-dominated horizontal heterolithic couplets; and 6) mud-draped, trough cross-stratified sand. Locally, tidal rhythmites were documented. The facies are interpreted as: 1) muddy, shallow, subaqueous flats/shoals; 2) palaeosols; 3) secondary tidal channels or run-off creeks; 4) tidally influenced point bars; 5) shoreface deposits; and 6) subtidal compound dunes. Thalassinoides-dominated Glossifungites ichnofacies, low-diversity expressions of the Skolithos ichnofacies and depauperate suites consisting of elements common to the Cruziana ichnofacies strongly indicate brackish-water conditions. However, continental trace fossil assemblages, with possible elements common to the Scoyenia ichnofacies, have also been identified. In addition to the palaeoenvironmental study, a local hydrogeochemical characterisation of the Pebas and Nauta formations was also conducted. The geochemistry of the groundwaters reflects the characteristics and the soil geochemistry of the geological formations studied. The Pebas formation has low hardness, acid to neutral waters, whereas the upper Pebas has high hardness, acid to neutral waters. In both units, the arsenic content is locally high. The Nauta formation has low hardness acid groundwaters. A regional review of the Pebas and Nauta formations placed the local observations into a continental perspective and suggests that the whole Pebas-Nauta system was a probably shallow (some tens of metres at maximum), brackish- to freshwater, tidally-influenced epicontinental embayment with a probable semi-diurnal to mixed tidal regime and a microtidal range, surrounded by continental environments such as forest floors, lagoons, rivers and their flood plains, and lakes.

Translation and Cross-Cultural Adaptation of the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema into Portuguese Language

Objective The objective of the study is to describe the process of translation and cross-cultural adaptation of the Lymphoedema Functioning, Disability, and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) into (Brazilian) Portuguese. Methods The process was comprised of five steps - translation, back translation, revision by an expert panel, pretest, and final translation. The first translation was performed by two professionals of the healthcare area, and the back translation was performed by two translators. An expert panel assessed the questions for semantics and idiomatic, cultural, and conceptual equivalence. The pretest was conducted on 10 patients with lymphedema. Results Small differences were identified between the translated and back-translated versions, which were revised by the expert panel. The patients included in the pretest found 10 questions difficult to understand; these questions were reassessed by the same expert panel. Conclusion The results of the translation and cross-cultural adaptation of the Lymph- ICF-LL resulted in a Brazilian Portuguese version, which still requires validation with various samples of the local population.

Osteology and radiographic anatomy of the hind limbs in Marshdeer (Blastocerus dichotomus)

Abstract: The knowledge of anatomical structures found in wild animals is important for the practice of medical and surgical clinic. Thus, the aim of this study was to describe the osteology and radiographic anatomy of the femur, patella, tibia, fibula, tarsal, metatarsal and phalanges of the Marshdeer Blastocerus dichotomus as a reference for clinical use and species identification. Most structures were similar to those found in domestic animals, with special features of this species. Noteworthy is, for example, the absence of the third trochanter of the femur. Although a ruminant, the Marshdeer has a fibuyla similar to the one described for the horse. B. dichotomus has four fingers on each limb, formed through three phalanges, only the third and fourth finger touch the ground, and the second and fifth finger is rudimentary. It has four proximal and two distal sesamoid bones, and sesamoid bones near the gastrocnemius muscle do not exist.

Upper Sambesi

Soitinnus: saksofonit (2), piano, rummut.

Similarity among periphyton algal communities in a lentic-lotic gradient of the upper Paraná river floodplain, Brazil

Floristic comparison of periphyton communities from three systems with different hydrodynamic regimes (lentic, semilotic, and lotic) was carried out during high and low water periods on the Upper Paraná River floodplain. For each period and system, glass slides were sampled every two days during 18-day periods, and Eichhornia azurea Kunth petioles were sampled three times. A total of 228 species was collected, representing 12 classes, mainly diatoms and desmids. The highest species-richness was found in communities from lentic system and during high water. Species richness in the lotic system was more stable over succession and hydrological periods. Algal taxonomic structure in river community was clearly separated from the other two systems, with 43% of similarity level. The hydrological period was next in importance, followed last by the substratum type, with communities associated at 65-78% similarity levels, depending on system and hydrological period. The type of system, but not the water levels,was the main factor that influenced community richness, followed by disturbances caused by flood pulses and the operation of reservoirs upstream. The periphyton on artificial and natural substrata presented high degree of similarity.

Alismatales from the upper and middle Araguaia river basin (Brazil)

The present study deals with a survey of the order Alismatales (except Araceae) in the upper and middle Araguaia River region located between the states of Mato Grosso and Goiás, Brazil. Field expeditions were carried out during the rainy and dry seasons. The route covered approximately 2,000 km and 41 aquatic environments were visited. Thirteen taxa, representing the families Alismataceae (nine), Hydrocharitaceae (three) and Najadaceae (one) were identified. Keys for the identification of families and species in field, brief diagnoses, schematic illustrations and relevant comments were elaborated based on field observations as well as on the analysis of the specimens collected.

Planktic Cyanobacteria from upper Tietê basin reservoirs, SP, Brazil

Considering the great ecological and sanitary importance of the cyanobacteria and the need of detailed information about these organisms in Brazilian water bodies, the present study aims at contributing towards the knowledge of the cyanobacterial flora of five reservoirs belonging to the upper Tietê Basin, São Paulo: Billings, Guarapiranga, Jundiaí, Pirapora, Ponte Nova and Taiaçupeba. In the past several years, these reservoirs have been submitted to severe environmental deterioration and have repeatedly presented cyanobacterial blooms, including those of toxic species. The samples were collected between 1997 and 2003 either with plankton net (20 µm mesh) or van Dorn's bottle, and preserved with lugol solution or formaldehyde. Some species were isolated and maintained in culture. Forty-eight species of cyanobacteria were identified, with predominance of the order Chroococcales (58%), followed by the orders Oscillatoriales (21%) and Nostocales (21%). Among the 48 studied species, 17 (35%) were considered potentially toxic. The occurrence and biodiversity of the cyanobacteria in each reservoir depend on the environmental conditions. Among the five water bodies, Billings Reservoir presented the most adequate situation for the development of a greater number of species (34), probably due to its high pH values (around 8). Pirapora Reservoir on the other hand, with highest conductivity (445.0 µS cm-1) and lowest Secchi depth values (0.2 m), presented the lowest cyanobacterial biodiversity (14 species).

Genetic variability of Prochilodus lineatus (Characiformes, Prochilodontidae) in the upper Paraná river

The genetic variability of the "curimba", Prochilodus lineatus, from three locations in the Paraná river basin, was investigated by starch gel electrophoresis. A total of 160 specimens were analyzed for 19 enzymes, 12 of which permitted successful interpretation of electrophoretic patterns. Eighteen loci were identified and six of them proved to be polymorphic (EST-1*, EST-2*, IDH-1*, PGM-1*, PGM-2*, LDH-2*). Mean heterozygosity was considered high (13%) by comparison with the literature. A low level of differentiation was found among subpopulations, with mean F ST = 0.018. Values of genetic distance and genetic identity suggest that, at least along this stretch of the river, P. lineatus comprises a single breed with high gene flow. This analysis has important implications for fishery management, aquaculture, and conservation of the stocks

An experimental model for the measurement of renal function after temporary ureteral obstruction in the rat

We present the results obtained with a ureterovesical implant after ipsilateral ureteral obstruction in the rat, suitable for the study of renal function after deobstruction in these animals. Thirty-seven male Wistar rats weighing 260 to 300 g were submitted to distal right ureteral ligation and divided into 3 groups, A (N = 13, 1 week of obstruction), B (N = 14, 2 weeks of obstruction) and C (N = 10, 3 weeks of obstruction). The animals were then submitted to ureterovesical implantation on the right side and nephrectomy on the left side. During the 4-week follow-up period serum levels of urea and creatinine were measured on the 2nd, 7th, 14th, 21st and 28th day and compared with preoperative levels. The ureterovesical implantation included a psoas hitch procedure and the ureter was pulled into the bladder using a transvesical suture. During the first week of the postoperative period 8 animals died, 4/13 in group A (1 week of obstruction) and 4/14 in group B (2 weeks of obstruction). When compared to preoperative serum levels, urea and creatinine showed a significant increase (P<0.05) on the 2nd postoperative day in groups A and B, with a gradual return to lower levels. However, the values in group B animals were higher than those in group A at the end of the follow-up. In group C, 2/10 animals (after 3 weeks of obstruction) were sacrificed at the time of ureterovesical implantation due to infection of the obstructed kidneys. The remaining animals in this group were operated upon but all of them died during the first week of follow-up due to renal failure. This technique of ureterovesical implantation in the rat provides effective drainage of the upper urinary tract, permitting the development of an experimental model for the study of long-term renal function after a period of ureteral obstruction

Entrepreneurship Education in Basic and Upper Secondary Education – Measurement and Empirical Evidence

The starting point of this study is to direct more attention to the teacher and those entrepreneurship education practices taking place in formal school to find out solutions for more effective promotion of entrepreneurship education. For this objective, the strategy-level aims of entrepreneurship education need to be operationalised into measurable and understandable teacher-level practices. Furthermore, to enable the effective development of entrepreneurship education in basic and upper secondary level education, more knowledge is needed of the state of affairs of entrepreneurship education in teaching. The purpose of the study is to increase the level of understanding of teachers’ entrepreneurship education practices, and through this to develop entrepreneurship education. This study builds on the literature on entrepreneurship education and especially those elements referring to the aims, resources, benefits, methods, and practises of entrepreneurship education. The study comprises five articles highlighting teachers’ role in entrepreneurship education. In the first article the concept of entrepreneurship and the teachers role in reflection upon his/hers approaches to entrepreneurship education are considered. The second article provides a detailed analysis of the process of developing a measurement tool to depict the teachers’ activities in entrepreneurship education. The next three articles highlight the teachers’ role in directing the entrepreneurship education in basic and upper secondary level education. Furthermore, they analyse the relationship between the entrepreneurship education practises and the teachers’ background characteristics. The results of the study suggest a wide range of conclusions and implications. First, in spite of many outspoken aims connected to entrepreneurship education, teachers have not set any aims for themselves. Additionally, aims and results seem to mix. However, it is possible to develop teachers’ target orientation by supporting their reflection skills, and through measurement and evaluation increase their understanding of their own practices. Second, applying a participatory action process it is possible to operationalise teachers’entrepreneurship education practices. It is central to include the practitioners’ perspective in the development of measures to make sure that the concepts and aims of entrepreneurship education are understood. Third, teachers’ demographic or tenure-related background characteristics do not affect their entrepreneurship education practices, but their training related to entrepreneurship education, participation in different school-level or regional planning, and their own capabilities support entrepreneurship education. Fourth, a large number of methods are applied to entrepreneurship education, and the most often used methods were different kinds of discussions, which seem to be an easy, low-threshold way for teachers to include entrepreneurship education regularly in their teaching. Field trips to business enterprises or inviting entrepreneurs to present their work in schools are used fairly seldom. Interestingly, visits outside the school are more common than visitors invited to the school. In line, most of the entrepreneurship education practices take place in a classroom. Therefore it seems to be useful to create and encourage teachers towards more in-depth cooperation with companies (e.g. via joint projects) and to network systematically. Finally, there are plenty of resources available for entrepreneurship education, such as ready-made materials, external stakeholders, support organisations, and learning games, but teachers have utilized them only marginally.